Academic journal article Bulletin of the World Health Organization

Use of Verbal Autopsy to Determine Mortality Patterns in an Urban Slum in Kolkata, India/Utilisation De L'autopsie Verbale Pour Detecter Des Modeles De Mortalite Dans Un Quartier Urbain Pauvre De Kolkata En Inde/Utilizacion De Las Autopsias Verbales Para Determinar Las Causas De Mortalidad En Un Barrio Urbano Pobre De Kolkata, India

Academic journal article Bulletin of the World Health Organization

Use of Verbal Autopsy to Determine Mortality Patterns in an Urban Slum in Kolkata, India/Utilisation De L'autopsie Verbale Pour Detecter Des Modeles De Mortalite Dans Un Quartier Urbain Pauvre De Kolkata En Inde/Utilizacion De Las Autopsias Verbales Para Determinar Las Causas De Mortalidad En Un Barrio Urbano Pobre De Kolkata, India

Article excerpt

Introduction

Mortality data are important indicators of population health and are crucial for setting priorities for health interventions and research. However, in areas with scanty resources little reliable information is available on mortality rates and causes of death since many deaths go unregistered. For example, in 2001 only 53% of the expected deaths in the Indian state of West Bengal were reported, according to national census data. (1) Even when they are available and accessible, death certificates may not be complete or reliable sources of cause of death data. Many deaths in developing countries do not occur in hospitals and death certificates are often signed by public officials who have not treated or as much as seen the deceased person.

In Kolkata (formerly Calcutta), the capital of West Bengal, an official death report is required before cremation can take place. Death registration records are therefore relatively complete. Nonetheless, the stated cause of death that is registered in hospitals, private clinics or police stations is not always reliable. If the deceased was seen by a health-care provider during the course of the illness leading to the death, the information may be accurate, bur because the poorest people generally have limited access to health care, accurate cause of death data seldom exists for them.

Verbal autopsy, an alternative method For collecting mortality data, enables investigators to establish the cause of death retrospectively. (2) The tool comprises a methodical interview with the next of kin or caregiver of the deceased to determine the symptoms and signs of the illness that preceded the death, and a review of medical records. Verbal autopsy is used by the Registrar General of India's Sample Registration System, the country's primary system for collecting demographic data, to estimate cause-specific mortality rates at the national and state levels. Studies in Tamil Nadu and in the state's capital of Chennai (formerly Madras) have shown that verbal autopsies can be used in rural and urban adult populations. (3,)4 A study in Ballabgarh in northern India showed that health workers can be trained to use the verbal autopsy to ascertain the cause of death among children under 5 years of age. (5)

The objective of this paper was to determine mortality patterns by cause, age group and gender in an urban slum in Kolkata by conducting surveillance of all deaths over a period of 18 months in a well-defined population. The surveillance was conducted in the context of a cholera and typhoid fever project. (6, 7)

Methods

Study site and census

Kolkata, with over 4 million residents, is one of the most populous cities in the world. The Kolkata Municipal Corporation is divided into 141 administrative wards. Our study site, which covered the slum areas of wards 29 and 30, is extremely overcrowded. (8) Water is available through municipal taps but only intermittently. Many households share common municipal latrines and sewage collects in open drains. Streets are narrow, with huts and small shops encroaching on the pavement.

A baseline de jure census was conducted in March 2003 to enumerate the study population and assign a unique identification number to each household and individual. The baseline study population consisted of 63 788 individuals. Households in the study area have 1.5 rooms on average, a median of 5 members (range, 1-30), and a median monthly family income of 67 United States dollars (US$). (9) Follow-up censuses were carried out in March and October 2004 to update demographic information.

Mortality surveillance

Surveillance for deaths was carried out from 1 May 2003 to 31 October 2004. Community health workers detected deaths through monthly visits to each household during which they recorded the name, age and address of the deceased. All deaths were reported to the study physicians, who conducted verbal autopsies after approximately 2 months; a grieving period was felt to be appropriate. …

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